Elective Primary C/S
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On our unit, Primary Elective C/S have become pretty popular, for this main reason, "I don't want to go through the pain of labor". Now, with that said some of these young ladies insist on also... Read More

Nov 24, '06

Joined: Apr '02; Posts: 38,771; Likes: 16,376

I am sorry; this is long and please feel free to pass by if you don't want to hear a very emotional opinion.

Now you all see why, despite my being an OB nurse (the profession of my dreams) has turned into a near-nightmar for me personally. I am seriously considering returning to school and getting myself away from the bedside or becoming a CBE. (I do have an offer to work for a lady I know owns a CBE business and it sounds tempting---but only if I can refrain from teaching people to expect perfection and painfree labor/delivery).

I am sad to say, I can't stand what (in some cases) we are doing to our (sometimes unaware) patients/babies. I feel like a partner in crime in certain cases and it hurts.

Yes, there are cases where interventions such as induction/cervical ripening/internal monitoring of mom and baby are indeed necessary. Yes----- there are times a csection (sorry, Steph that term does not bother me that much----it is what it is, to me, anyhow) are needed. I myself have undergone csection for my breech daughter who refused to turn and was big ------9lb at 38 weeks ---I am only 5 feet 2. A version would likely have been trouble for me. So I am not anti-csection. I am anti convenience csection and intervention. Having "done" both types of deliveries personally, I can say with conviction, a vaginal delivery is no walk in the park (I had a 3rd deg lac)----- but is easier to recover from than a csection. If I were to have another baby, I probably would undergo elective repeat c/s, just because I don't labor easily and don't care to raise my risks of uterine rupture even less than 1%. But I realize, that is just me; I think all families should have the opportunity to make truly informed choices regarding their birth experiences.

I feel we (medical personnel) are taking it away---or at least eroding the choice, from them in so many ways, from disallowing TOLAC to advertising "one stop" surgical "parties". (that is horrifying to me that we are even doing this anyplace).

I find these trends disturbing and personally depressing. This is not what I signed up for as an OB nurse----to possibly do harm in over-intervening. To watch people making clearly ill-informed choices that raise the risks for themselves and babies in the process----gets harder for me every year I am a nurse. So, I have to weigh my future options. I am not sure I can do well in obstetric nursing in the future. And I have only done this 9 years, so I am deeply saddened to say I feel this way so darn soon.

Anyhow I realize I have LONG digressed. If you read any of this and relate, thank you and let me know!

deb

Last edit by SmilingBluEyes on Nov 24, '06

Nov 24, '06

Joined: Dec '02; Posts: 41,761; Likes: 48,082

Deb - My feelings about the term c-section are my own little problem. No worries.

I appreciate your post. I'm grateful that we don't have the same kinds of issues you have and also grateful that I only do OB part of the time as a rural nurse. I mostly work acute and ER.

I think every area of nursing has its own challenges . . .I just finished a book by Pamela Grim, which I mentioned on another thread today. She is an ER doc who has served in foreign medical missions in Nigeria and Bosnia and other places, plus the inner city ER. The book was about her struggle with so much of the awful parts of the ER experience.

We all have to make choices based on our own best interests and the interests of our family.

I still think the cesarean was better than the feeling of not having any say over my body during labor. (Maybe the abuse I suffered as a child has something to do with that feeling - I'm not sure). But just like others who have terrors of epidurals, we each get to own our experiences.

I wish you clarity Deb.

steph

Nov 24, '06

Joined: Apr '02; Posts: 38,771; Likes: 16,376

Thank you Steph. Like I said, I don't think surgical delivery (is that any better lol) is all bad. There are clearly times when this is best. Your case was one, mine another. But I don't think electing to undergo primary surgical delivery is wise or safe. I think the more we push Mother Nature, the more She will SHOVE us back----and that truly has me concerned.

I thank you; clarity is what is needed for me. I am just heartbroken, as OB is turning into something I can hardly recognize even after just 9 years. I really yearn to work with midwives more in lower-intervention settings. But even these are becoming increasingly rare in the good ole USA.

I also can't help that I know a surgical method of delivery nets more $$$ for the hospitals and doctors in so many cases. But hey, I am really digressing now aren't I.

Thank you Steph. Like I said, I don't think surgical delivery (is that any better lol) is all bad. There are clearly times when this is best. Your case was one, mine another. But I don't think electing to undergo primary surgical delivery is wise or safe. I think the more we push Mother Nature, the more She will SHOVE us back----and that truly has me concerned.

I thank you; clarity is what is needed for me. I am just heartbroken, as OB is turning into something I can hardly recognize even after just 9 years. I really yearn to work with midwives more in lower-intervention settings. But even these are becoming increasingly rare in the good ole USA.

I also can't help that I know a surgical method of delivery nets more $$$ for the hospitals and doctors in so many cases. But hey, I am really digressing now aren't I.

I agree . .. electing to undergo cesarean delivery is not wise or safe.

I am not an OB nurse but it gives me chills when I hear moms to be say they want c-sections to keep from pains of labor, chose due dates. I want to scream hello major abdominal surgery. Complications can arise. And as a critical care nurse I don't want to be taking care of a post partem mom where something "happened" during their primary elective section. Now that being said I have delivered by both routes. Vag with 1st, second was an elective section due to a list of medical reasons for baby and me. I have the issue of my section was easier to recover from than my vaginal birth. I told this to my ob and she said this was not something you heard everyday. I try to shy away from telling this to first time moms because I don't want them to try to get a elective section because it may be easier.

About the epidural thing - I do understand! I am terrified of them, but not of general anesthesia because I've been under that before and did fine. There are risks with both types of anesthesia, and people fear each type for different reasons. I would agree to an epidural for a c-section because I know in that case it's more safe, plus I'd get to keep it for a bit post-delivery for pain relief. But if I was going for, say, a hernia repair and they offered both options, I'd pick general over epidural in a heartbeat. People just have different fears, that's all. And I'm apparently not alone in my fear of having a needle shoved into my back! Makes me nauseous just thinking about it!

About Britney Spears - I read it was four weeks early, not six for her sections. Her last son was 6-11, so there is no way he was a 34-weeker. Either way, it's sick. Do you think the same thing happened to Angelina Jolie? I was shocked when I heard she had a section - she is so fit that I thought she'd push that baby out in record time. Maybe they do tummy tucks at the same time? I seriously wouldn't put it past them...

I'm not so sure what the fright regarding epidurals is about??? I had two when I had both my children. Both hurt less than having an IV put in. Both were done in less than 5 minutes and were TOTALLY worth it. Now I have seen epidural placements take a while on obese pts or pts w/ peculiar anatomy, but i've never seen them not get it in. And more often than not the pts are happy they got it in the end.
As for the Angelina Jolie thing, i read she had a P C/S due to breech for the entire pregnancy. Who knows if its true. Guess they don't like to do breech deliveries either in whatever country it was that she delivered.

I have given birth 4 times. 2 vaginally and 2 by emergency c-sections. The vag deliveries are 200 times easier to recover from. The first c-section was after extensive labor with major complications for both me and the baby (the baby already had problems prior to labor/surgery). It was easier to recover from the second section because I did not labor first, but it was still not as easy as recovery from a vag delivery.

It worries me that we deliver most babies at the convenience of mom and or the MD. Like was said earlier, some day mother nature is going to push back! I hope that I am not in the delivery room at that time!!!

I'm not so sure what the fright regarding epidurals is about??? I had two when I had both my children. Both hurt less than having an IV put in. Both were done in less than 5 minutes and were TOTALLY worth it. Now I have seen epidural placements take a while on obese pts or pts w/ peculiar anatomy, but i've never seen them not get it in. And more often than not the pts are happy they got it in the end.

I really can't explain my fear of epidurals. We all have irrational fears in life, and that just happens to be one of mine, pure and simple. I am also overweight and have scoliosis. When I bend over, you sure as heck don't see a nice spine poking out. It won't be an easy poke. I've seen many epidurals placed in L&D and many spinal taps in the NICU - I can't stand watching either of them.

My doctor told me the other day that the earliest our hospital electively induces moms is 39 weeks. She also said that if the baby measures 9-10 pounds at that time, she'll "just schedule a c-section" instead. I really don't want a section, so I did ask about inducing early for size. She said it was a no go - that there were more complications with preterm delivery than there were with c-sections, and as a NICU nurse I should know that. So I feel like I have absolutely no options here.

I doubt your baby will weigh 10 lbs. Besides, I delivered my first baby, a 9Lb. daughter, without even needing so much as a stitch. It can be done. (The largest uncomplicated vag. baby I've taken care of was 12 pounds.)

I'm probably preaching to the choir, but...
Remember, you are the patient. It's YOUR body. You have the right to give informed consent and to REFUSE treatment. You can refuse an elective C/S. Insist on trying labor. You don't have to do everything your doctor says. If your doc gives you a hard time, find another doc -- or better yet, see a midwife. You'd have the best chance at a normal delivery and the best care with them anyway.

In the end, any anesthesia provider who does general anesthetic for no other reason than needles in the back give mom the willies are taking an enormous risk.

So, please, then tell us how you cope with the emotional and potentially very bad psychiatic needs of one who "has the willies" as you have glibly put it? I can assure, I don't have the willies about a needle in my back. It scares the c**p out of me.

And I think that any care-giver who ignores a patient's wishes or concerns and gives them no other choice is asking for a lawsuit. I totally understand the concerns from the physiological standpoint, but we should always be looking at the big picture.

Nov 25, '06

Joined: Apr '06; Posts: 93; Likes: 17

Passgasser is not exaggerating. General anesthesia in a pregnant patient is risky, that is why its reserved for emergencies. Refusing to do a general because a patient is scared of needles is not cause for a lawsuit. Having an aspiration while inducing a patient who wants a general because she is afraid of needles is. The safest choice for mom and baby for an elective c-section is regional anesthesia. My own personal opinion is I would do whatever is safest for my baby, even if I'm scared of something. I would also want to be present and awake for the birth of my child.

And I think that any care-giver who ignores a patient's wishes or concerns and gives them no other choice is asking for a lawsuit.

So you think that an anesthesia provider refusing to provide you with unsafe care is asking for a lawsuit? Umm, no.

It is standard of care that GETA is reserved for C-sec emergencies or those cases in which subarachnoid block or epidural would be contraindicated or has failed. Do you seriously think an anesthesia provider should be forced to provide you with whatever type of anesthetic you want, regardless of the risks? And you do have a choice. You always have a choice. It just might not be the choice you want. You can choose to have a neuraxial technique, or you can choose to have local anesthesia only for this major abdominal procedure, or you can choose not to have this ELECTIVE case done, at least not with the prudent anesthesia provider who is unwilling to risk your life by providing you with substandard care.

I just find it odd that you think a provider has a duty to provide you with whatever kind of care you demand, regardless of practice standards or risks involved. A provider does not have a duty to provide you with whatever you want just because you want it. They may not be able to force you to do anything against your will, however, they can refuse to provide unsafe care to you.

So you think that an anesthesia provider refusing to provide you with unsafe care is asking for a lawsuit? Umm, no.

It is standard of care that GETA is reserved for C-sec emergencies or those cases in which subarachnoid block or epidural would be contraindicated or has failed. Do you seriously think an anesthesia provider should be forced to provide you with whatever type of anesthetic you want, regardless of the risks? And you do have a choice. You can choose to have a neuraxial technique, or you can choose to have local anesthesia only for this major abdominal procedure, or you can choose not to have this ELECTIVE case done, at least not with the prudent anesthesia provider who is unwilling to risk your life by providing you with substandard care.

I just find it odd that you think a provider has a duty to provide you with whatever kind of care you demand, regardless of practice standards or risks involved.

Well, first of all, I would NEVER elect to have a c-section. So I guess right there, it would be emergent and you could feel better about puting me to sleep. And my two kids were born without anesthesia, also by choice. I do believe that if you have a mom that is clearly extremely anxious about an epidural, then other avenues should be explored. I can see a situation where a bad experience, out of fear, with an epidural could overshadow the happiness of the birth and MAYBE mess with the bonding.

It's just my opinion and my feelings, and I know, logically, they are probably unfounded. I also know that others do not have that fear, but for sure there are others out there. Please, try to see it as a personal thing, of mine. I've clearly stated it is MY fear.